Highly focused anopheline breeding sites and malaria transmission in Dakar

<p>Abstract</p> <p>Background</p> <p>Urbanization has a great impact on the composition of the vector system and malaria transmission dynamics. In Dakar, some malaria cases are autochthonous but parasite rates and incidences of clinical malaria attacks have been recorded at low levels. Ecological heterogeneity of malaria transmission was investigated in Dakar, in order to characterize the <it>Anopheles </it>breeding sites in the city and to study the dynamics of larval density and adult aggressiveness in ten characteristically different urban areas.</p> <p>Methods</p> <p>Ten study areas were sampled in Dakar and Pikine. Mosquitoes were collected by human landing collection during four nights in each area (120 person-nights). The <it>Plasmodium falciparum </it>circumsporozoite (CSP) index was measured by ELISA and the entomological inoculation rates (EIR) were calculated. Open water collections in the study areas were monitored weekly for physico-chemical characterization and the presence of anopheline larvae. Adult mosquitoes and hatched larvae were identified morphologically and by molecular methods.</p> <p>Results</p> <p>In September-October 2007, 19,451 adult mosquitoes were caught among which, 1,101 were <it>Anopheles gambiae s.l</it>. The Human Biting Rate ranged from 0.1 bites per person per night in Yoff Village to 43.7 in Almadies. Seven out of 1,101 <it>An. gambiae s.l</it>. were found to be positive for <it>P. falciparum </it>(CSP index = 0.64%). EIR ranged from 0 infected bites per person per year in Yoff Village to 16.8 in Almadies. The <it>An</it>. <it>gambiae </it>complex population was composed of <it>Anopheles arabiensis </it>(94.8%) and <it>Anopheles melas </it>(5.2%). None of the <it>An. melas </it>were infected with <it>P. falciparum</it>. Of the 54 water collection sites monitored, 33 (61.1%) served as anopheline breeding sites on at least one observation. No <it>An</it>. <it>melas </it>was identified among the larval samples. Some physico-chemical characteristics of water bodies were associated with the presence/absence of anopheline larvae and with larval density. A very close parallel between larval and adult densities was found in six of the ten study areas.</p> <p>Conclusion</p> <p>The results provide evidence of malaria transmission in downtown Dakar and its surrounding suburbs. Spatial heterogeneity of human biting rates was very marked and malaria transmission was highly focal. In Dakar, mean figures for transmission would not provide a comprehensive picture of the entomological situation; risk evaluation should therefore be undertaken on a small scale.</p

Determinants of compliance with malaria chemoprophylaxis among French soldiers during missions in inter-tropical Africa

International audienc

Malaria transmission in Dakar: A two-year survey

<p>Abstract</p> <p>Background</p> <p>According to entomological studies conducted over the past 30 years, there was low malaria transmission in suburb of Dakar but little evidence of it in the downtown area. However; there was some evidence of local transmission based on reports of malaria among permanent residents. An entomological evaluation of malaria transmission was conducted from May 2005 to October 2006 in two areas of Dakar.</p> <p>Methods</p> <p>Mosquitoes were sampled by human landing collection during 34 nights in seven places in Bel-air area (238 person-nights) and during 24 nights in five places in Ouakam area (120 person-nights). Mosquitoes were identified morphologically and by molecular methods. The <it>Plasmodium falciparum </it>circumsporozoïte indexes were measured by ELISA, and the entomological inoculation rates (EIR) were calculated for both areas. Molecular assessments of pyrethroid knock down resistance (<it>Kdr</it>) and of insensitive acetylcholinesterase resistance were conducted.</p> <p>Results</p> <p>From May 2005 to October 2006, 4,117 and 797 <it>Anopheles gambiae s.l</it>. respectively were caught in Bel-air and Ouakam. Three members of the complex were present: <it>Anopheles arabiensis </it>(> 98%), <it>Anopheles melas </it>(< 1%) and <it>An. gambiae s.s</it>. molecular form M (< 1%). Infected mosquitoes were caught only during the wintering period between September and November in both places. In 2005 and 2006, annual EIRs were 9,5 and 4, respectively, in Bel-air and 3 and 3, respectively, in Ouakam. The proportion of host-seeking <it>An. gambiae s.l</it>. captured indoors were 17% and 51% in Bel air and Ouakam, respectively. Ace 1 mutations were not identified in both members of the <it>An. gambiae </it>complex. <it>Kdr </it>mutation frequency in <it>An. arabiensis </it>was 12% in Bel-air and 9% in Ouakam.</p> <p>Conclusion</p> <p>Malaria is transmitted in Dakar downtown area. Infected mosquitoes were caught in two subsequent years during the wintering period in two distant quarters of Dakar. These data agree with clinical data from a Senegalese military Hospital of Dakar (Hospital Principal) where most malaria cases occurred between October and December. It was the first detection of <it>An. melas </it>in Dakar.</p

Determinants of compliance with anti-vectorial protective measures among non-immune travellers during missions to tropical Africa

International audienceThe effectiveness of anti-vectorial malaria protective measures in travellers and expatriates is hampered by incorrect compliance. The objective of the present study was to identify the determinants of compliance with anti-vectorial protective measures (AVPMs) in this population that is particularly at risk because of their lack of immunity

Conditions of malaria transmission in Dakar from 2007 to 2010

Background: Previous studies in Dakar have highlighted the spatial and temporal heterogeneity of Anopheles gambiae s.l. biting rates. In order to improve the knowledge of the determinants of malaria transmission in this city, the present study reports the results of an extensive entomological survey that was conducted in 45 areas in Dakar from 2007 to 2010. Methods: Water collections were monitored for the presence of anopheline larvae. Adult mosquitoes were sampled by human landing collection. Plasmodium falciparum circumsporozoite (CSP) protein indexes were measured by ELISA (enzyme-linked immunosorbent assay), and the entomological inoculation rates were calculated. Results: The presence of anopheline larvae were recorded in 1,015 out of 2,683 observations made from 325 water collections. A water pH of equal to or above 8.0, a water temperature that was equal to or above 30 degrees C, the absence of larvivorous fishes, the wet season, the presence of surface vegetation, the persistence of water and location in a slightly urbanised area were significantly associated with the presence of anopheline larvae and/or with a higher density of anopheline larvae. Most of the larval habitats were observed in public areas, i.e., freely accessible. A total of 496,310 adult mosquitoes were caught during 3096 person-nights, and 44967 of these specimens were identified as An. gambiae s.l. The mean An. gambiae s.l. human-biting rate ranged from 0.1 to 248.9 bites per person per night during the rainy season. Anopheles arabiensis (93.14%), Anopheles melas (6.83%) and An. gambiae s.s. M form (0.03%) were the three members of the An. gambiae complex. Fifty-two An. arabiensis and two An. melas specimens were CSP-positive, and the annual CSP index was 0.64% in 2007, 0.09% in 2008-2009 and 0.12% in 2009-2010. In the studied areas, the average EIR ranged from 0 to 17.6 infected bites per person during the entire transmission season. Conclusion: The spatial and temporal heterogeneity of An. gambiae s.l. larval density, adult human-biting rate (HBR) and malaria transmission in Dakar has been confirmed, and the environmental factors associated with this heterogeneity have been identified. These results pave the way for the creation of malaria risk maps and for a focused anti-vectorial control strategy

IgG responses to the gSG6-P1 salivary peptide for evaluating human exposure to Anopheles bites in urban areas of Dakar region, Sénégal

<p>Abstract</p> <p>Background</p> <p>Urban malaria can be a serious public health problem in Africa. Human-landing catches of mosquitoes, a standard entomological method to assess human exposure to malaria vector bites, can lack sensitivity in areas where exposure is low. A simple and highly sensitive tool could be a complementary indicator for evaluating malaria exposure in such epidemiological contexts. The human antibody response to the specific <it>Anopheles </it>gSG6-P1 salivary peptide have been described as an adequate tool biomarker for a reliable assessment of human exposure level to <it>Anopheles </it>bites. The aim of this study was to use this biomarker to evaluate the human exposure to <it>Anopheles </it>mosquito bites in urban settings of Dakar (Senegal), one of the largest cities in West Africa, where <it>Anopheles </it>biting rates and malaria transmission are supposed to be low.</p> <p>Methods</p> <p>One cross-sectional study concerning 1,010 (505 households) children (n = 505) and adults (n = 505) living in 16 districts of downtown Dakar and its suburbs was performed from October to December 2008. The IgG responses to gSG6-P1 peptide have been assessed and compared to entomological data obtained in or near the same district.</p> <p>Results</p> <p>Considerable individual variations in anti-gSG6-P1 IgG levels were observed between and within districts. In spite of this individual heterogeneity, the median level of specific IgG and the percentage of immune responders differed significantly between districts. A positive and significant association was observed between the exposure levels to <it>Anopheles gambiae </it>bites, estimated by classical entomological methods, and the median IgG levels or the percentage of immune responders measuring the contact between human populations and <it>Anopheles </it>mosquitoes. Interestingly, immunological parameters seemed to better discriminate the exposure level to <it>Anopheles </it>bites between different exposure groups of districts.</p> <p>Conclusions</p> <p>Specific human IgG responses to gSG6-P1 peptide biomarker represent, at the population and individual levels, a credible new alternative tool to assess accurately the heterogeneity of exposure level to <it>Anopheles </it>bites and malaria risk in low urban transmission areas. The development of such biomarker tool would be particularly relevant for mapping and monitoring malaria risk and for measuring the efficiency of vector control strategies in these specific settings.</p

Intensified tuberculosis treatment to reduce the mortality of HIV-infected and uninfected patients with tuberculosis meningitis (INTENSE-TBM): study protocol for a phase III randomized controlled trial

BACKGROUND: Tuberculous meningitis (TBM) is the most lethal and disabling form of tuberculosis (TB), particularly in sub-Saharan Africa. Current anti-TB treatment is poorly effective since TBM mortality reaches 40% in HIV-negative patients and up to 70% in HIV-co-infected patients. To reduce TBM-induced morbidity and mortality, the INTENSE-TBM trial evaluates two interventions in both HIV-infected and uninfected patients: an anti-TB treatment intensification using oral high-dose rifampicin (35 mg/kg daily) and linezolid (1200 mg daily and then 600 mg daily) during the first 8 weeks of the anti-TB treatment and the use of adjunctive aspirin (200 mg daily). METHODS: This is a randomized controlled, phase III, multicenter, 2 × 2 factorial plan superiority trial. The trial has four arms, combining the two experimental treatments (intensified TBM regimen and aspirin) with the two reference treatments (WHO standard TB treatment and placebo), and is open-label for anti-TB treatment and double-blind placebo-controlled for aspirin treatment. This trial is conducted in adults or adolescents of age ≥15 years with TBM defined as "definite," "probable," or "possible" using Tuberculosis Meningitis International Research Consortium criteria, in four African countries: Ivory Coast, Madagascar, Uganda, and South Africa. The primary outcome is all-cause death between inclusion and week 40. DISCUSSION: The INTENSE-TBM trial represents a key opportunity to enhance TBM treatment with widely available existing drugs notably in high-incidence settings of both TB and HIV. The trial design is pragmatic and the results will permit early and effective applications in TBM patient care, in both HIV and TB high-incidence countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT04145258. Registered on October 30, 2019

Use of satellite earth observation data for the evaluation and prediction of vectorial densities and malaria transmission risk

Malgré les efforts nationaux et internationaux, le paludisme reste un problème de santépublique majeur dans de nombreux pays et les systèmes de santé ont des difficultés pourévaluer son poids réel, le risque de transmission des plasmodiums et leur répartitiongéographique. Pourtant, l’hétérogénéité spatiale du paludisme peut être importante et dans cecontexte de concentration du risque, la lutte contre la maladie peut gagner à être focaliséedans certains lieux et certaines périodes. D’une part, l’environnement est un déterminantmajeur de la biodiversité du paludisme à cause du caractère vectoriel de la transmission et despréférences bioécologiques des vecteurs. D’autre part, les satellites en orbite peuvent fournirdes données environnementales, climatiques et météorologiques qui ont déjà été utilisées pourl’étude de maladies infectieuses. La « télé-épidémiologie » a été définie comme une approcheintégrée visant à associer des données médicales, épidémiologiques ou entomologiques deterrain à des données environnementales obtenues par satellites, en s’appuyant sur lacompréhension et la mesure des mécanismes physiques et biologiques qui sont en jeu. Dansles villes, il a déjà été possible de mettre en évidence, en utilisant des données satellites à deséchelles appropriés, des associations entre des éléments urbains cartographiés et desindicateurs paludométriques. Chez des voyageurs, dans l’objectif d’une évaluation du risquede contracter le paludisme ou de l’efficacité de mesures prophylactiques, il serait utile depouvoir évaluer et prédire les niveaux d’exposition à la transmission dans les différenteslocalités parcourues. L’objectif général des travaux de la présente thèse était d’identifier desfacteurs environnementaux mesurables par satellite et utilisables pour l’évaluation du risquede paludisme chez les voyageurs d’une part et en milieu urbain d’autre part.Tout d’abord, des données de télédétection ont été utilisées pour évaluer les niveauxd’expositions au risque de paludisme d’une population de militaires, dans le cadre d’un travailsur l’estimation de leurs facteurs de risque d’accès palustre. Les résultats ont montré que,même en prenant en compte les facteurs de confusion de l’âge et de l’observance de lachimioprophylaxie, l’environnement était le principal facteur associé au risque de survenued’accès palustres.En parallèle, une large collecte de données entomologiques a été effectuée pendant cinq ansdans la ville de Dakar et a permis de mettre en évidence une très forte hétérogénéité spatiale ettemporelle de la transmission du paludisme dans la ville. Les informations collectées ont étécentralisées dans une base de données géoréférencée (SIG - Système d’InformationGéographique) contenant toutes les variables entomologiques, environnementales,météorologiques, biologiques et physiques relevées sur le terrain ou par satellites.Puis un travail de modélisation du risque entomologique dans la capitale du Sénégal, basé surles données collectées sur le terrain et sur des données environnementales issues d’imagessatellites a été mené. Une première étape a permis de mettre en évidence les évolutions deszones à risque de transmission et d’affirmer que le pourcentage de la population dakaroise àfort risque de transmission avait diminué entre 1996 et 2007. Une deuxième étape a conduit àl’élaboration de 1) une carte des gîtes larvaires accompagné d’un indice de productivité dansla ville de Dakar, 2) une carte des densités d’agressivité des anophèles adultes, puis 3) cescartes étaient rendues dynamiques, c'est-à-dire que les variations temporelles liées auxvariations de leurs déterminants météorologiques étaient prises en compte.Les résultats des travaux de thèse ont montré que des données de télédétection associées à unegrande quantité de données de terrain peuvent permettre l’ajustement de modèles prédictifs etla construction de cartes de risque entomologique, en milieu urbain ou pour des populationsmobiles.Despite national an international efforts, malaria remains a major public health in manycountries and sanitary systems are hindered by the lack of information on the actual burden ofmalaria, on the plasmodium transmission risk and on their geographical distribution.Nevertheless, spatial heterogeneity can be important and in this context, malaria control couldbe improved if could be focused in place and time. On one hand, the environment is a majordeterminant of malaria biodiversity, because of the vectorial transmission and the vectorsbioecological preferences. On another hand, orbiting satellites can provide environmental,climatic and meteorological data that already have been used for the study of infectiousdiseases. “Tele-epidemiology” has been defined as an integrated approach aiming atassociating medical, epidemiological or entomological ground data, with remotely-sensedenvironmental data, based on the in depth comprehension and measurement of the involvedphysical and biological mechanisms. In cities, it has already been possible to highlightassociations between mapped urban settings and malariometric indices, using satellite data atappropriate scales. Among travellers, in the objective to evaluate malaria risk or efficacy ofprophylactic devices, it would be useful to evaluate and predict transmission levels in thevisited places. The objective of the present thesis was to identify environmental factors thatcould be remotely-sensed and that could be used in the evaluation of malaria risk amongtravellers on one hand and in urban settings on the other hand.First, remotely-sensed data have been used to evaluate levels of exposure to malaria risk ofmilitaries, in the scope of a study on their risk factors for clinical malaria. Results haveshowed that, even when taking into account age and compliance to chemoprophylaxis asconfusion factors, the environment was the factor the most strongly associated to clinicalmalaria risk.In parallel, an extensive entomological study has been conducted during five years in Dakarand allowed demonstrating a strong spatial and temporal heterogeneity of malariatransmission in the city. Collected information were centralized in a georeferenced database(GIS - Geographic Information System) containing all entomological, environmental,meteorological, biological and physical data collected on the field or by remote sensing.Finally, modelling of entomological risk in the capital city of Senegal was undertaken, basedon data collected on the ground and environmental data issued from satellites. A first stepshowed the evolution of malaria transmission risk areas and allowed declaring that thefraction of human population that was at high risk for transmission decreased between 1996and 2007. A second step led to the development of 1) a map of the breeding sites with aproductivity indicator in Dakar city, 2) a map of aggressive adult Anopheles densities, and 3)a dynamic aspect was added to those maps, taking into account the variations of theirmeteorological determinants.The results of the work undertaken in this thesis demonstrated that remotely-sensedinformation, associated with a large amount of ground data, allow to adjust predictive models and to draw entomological risk maps, in urban settings or for moving population